Integumentary Function Of A 40-Year-Old White Female ✓ Solved

Integumentary Functionkb Is A 40 Year Old White Female With A 5 Yea

Describe the most common triggers for psoriasis and explain the different clinical types. Discuss the various treatment options for psoriasis, including pharmacological and non-pharmacological approaches, and identify the most appropriate treatment for a patient experiencing a relapse, considering her history and current presentation. Emphasize the importance of medication review and reconciliation in this context. Additionally, outline other potential manifestations of psoriasis.

Sample Paper For Above instruction

Psoriasis is a chronic, immune-mediated skin disorder characterized by hyperproliferation of keratinocytes, leading to the formation of scaly, erythematous plaques. It affects approximately 2-3% of the population and manifests through various clinical types, each with distinct features and management considerations. Understanding the triggers and treatment modalities is essential for effective disease control, especially during relapse episodes like that experienced by K.B., a 40-year-old woman with a history of psoriasis.

Common Triggers for Psoriasis

Multiple environmental, physiological, and lifestyle factors can provoke or exacerbate psoriasis. Recognized triggers include stress, infections, injury to the skin (Koebner phenomenon), certain medications (e.g., beta-blockers, lithium, antimalarials), smoking, excessive alcohol consumption, and hormonal changes. Infections, particularly streptococcal pharyngitis, are known precipitating factors, especially for guttate psoriasis. Stress impairs immune regulation, potentially triggering flares, while skin trauma induces local inflammation, leading to new psoriatic plaques. Medications like beta-blockers and NSAIDs may also worsen psoriasis symptoms, underscoring the importance of medication review in management.

Clinical Types of Psoriasis

Psoriasis presents in several clinical forms, with plaque psoriasis (psoriasis vulgaris) being the most prevalent. Other types include:

  • Guttate psoriasis: Appears as small, drop-shaped lesions, often triggered by infections, especially streptococcal pharyngitis.
  • Pustular psoriasis: Characterized by white pustules on erythematous bases, which can be localized (palmar-plantar) or generalized.
  • Inverse psoriasis: Involves intertriginous areas such as axillae and groin, with smooth, shiny patches.
  • Erythrodermic psoriasis: Severe, widespread redness, scaling, and systemic symptoms, often precipitated by abrupt withdrawal of systemic therapy or infection.

Management of Psoriasis

The treatment of psoriasis aims to reduce inflammation, control keratinocyte proliferation, and improve quality of life. Options depend on disease severity, extent, and patient-specific factors. The main categories include topical therapies, phototherapy, systemic agents, and biologic therapies.

Topical Treatments

First-line therapy for mild to moderate psoriasis involves corticosteroids, vitamin D analogs (calcipotriol), coal tar, anthralin, and moisturizers. High-potency corticosteroids effectively reduce inflammation and plaque thickness but require cautious use to prevent skin atrophy. Vitamin D analogs help normalize keratinocyte proliferation.

Phototherapy

Ultraviolet B (UVB) phototherapy is beneficial for moderate disease, involving controlled exposure to natural or artificial UVB to slow keratinocyte growth.

Systemic Therapies

Moderate to severe psoriasis often necessitates systemic medications such as methotrexate, cyclosporine, acitretin, or apremilast. These agents modulate immune responses and keratinocyte activity but require monitoring for adverse effects.

Biologic Agents

Biologics target specific immune pathways involved in psoriasis pathogenesis, including tumor necrosis factor-alpha (TNF-α) inhibitors (e.g., etanercept, infliximab), interleukin (IL)-17 inhibitors (e.g., secukinumab), and IL-23 inhibitors (e.g., guselkumab). They are indicated for refractory cases or extensive disease.

Treatment Approach for K.B.'s Relapse

Considering K.B.'s history of remission and now experiencing a widespread flare-up involving large areas, a stepped approach is appropriate. Initially, topical therapies with high-potency corticosteroids combined with vitamin D analogs would be recommended to control symptoms rapidly. Given the extensive involvement, phototherapy, specifically narrowband UVB, could be highly effective and safe for short-term use. If topical treatments are insufficient, systemic therapy with a biologic agent targeting specific cytokines involved in psoriasis (e.g., IL-17 or IL-23 inhibitors) should be considered, especially to induce remission swiftly and prevent further relapses. The choice of therapy also depends on comorbidities, patient preferences, and previous treatment responses.

Non-Pharmacological Strategies

Non-pharmacological management includes phototherapy, lifestyle modifications, and stress reduction techniques. Regular moisturization with emollients helps reduce scaling and itching. Stress management through relaxation techniques, counseling, or mindfulness interventions can decrease relapse frequency. Avoiding known triggers such as skin trauma, infections, and certain medications is vital. Nutritional strategies, including a balanced diet rich in omega-3 fatty acids, may also have anti-inflammatory benefits. Patients should be educated about psoriasis as a chronic condition, emphasizing adherence to treatment and monitoring for potential side effects.

Importance of Medication Review and Reconciliation

In patients with psoriasis, especially during treatment relapses, medication review is crucial. Certain drugs can exacerbate psoriasis or interfere with treatment efficacy. For K.B., knowing her current medications (e.g., topical, systemic, or over-the-counter agents) helps identify potential triggers or drug interactions. It is essential to evaluate for drugs like beta-blockers, NSAIDs, or antimalarials, which may precipitate or worsen psoriasis. Additionally, reviewing medications ensures no contraindicated agents are being used concurrently with psoriasis treatments, maximizing therapeutic benefit and minimizing adverse effects. This process enhances personalized care and supports better disease management.

Other Manifestations of Psoriasis

Beyond skin lesions, psoriasis can involve various systemic manifestations, including psoriatic arthritis, which causes joint pain, swelling, and stiffness. Nail involvement occurs in about 50% of cases, presenting as pitting, onycholysis, or oil spots. Psoriasis is also associated with comorbidities such as cardiovascular disease, metabolic syndrome, depression, and inflammatory bowel disease, underscoring its systemic impact. Recognizing these manifestations facilitates comprehensive management and improves overall patient outcomes.

Conclusion

In summary, psoriasis is a multifaceted chronic disease influenced by environmental triggers, genetic predisposition, and immune dysregulation. Effective management requires an understanding of its clinical types, triggers, and treatment options—ranging from topical agents to biologic therapies. For K.B., a personalized approach combining pharmacological and non-pharmacological strategies, along with vigilant medication review, is essential for controlling her relapse and preventing future episodes. Addressing systemic associations and manifestations further enhances patient care, emphasizing the importance of a holistic management plan rooted in current evidence-based practices.

References

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  • Kiankhooy, Y., & Rad, M. (2015). Triggers and management of psoriasis. Iranian Journal of Dermatology, 18(3), 134-139.
  • Menter, A., et al. (2019). Guidelines of care for the management of psoriasis and psoriatic arthritis. Journal of the American Academy of Dermatology, 80(4), 1029-1040.
  • Greb, J. E., et al. (2016). Psoriasis. Nature Reviews Disease Primers, 2, 16082.
  • Parisi, R., et al. (2013). Global epidemiology of psoriasis: A systematic review of prevalence and incidence. Journal of Investigative Dermatology, 133(2), 377-385.
  • Langley, R. G., et al. (2014). Treatment of psoriasis: Role of biologic agents. American Journal of Clinical Dermatology, 15(2), 113-127.
  • Choudhury, S., & Hevia, C. (2021). Non-pharmacological management of psoriasis. Dermatologic Clinics, 39(3), 319-330.
  • Umezawa, Y., et al. (2020). Pathogenesis and treatment of psoriasis. Journal of Dermatology, 47(10), 1017-1024.
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  • Armstrong, A. W., & Read, C. (2020). Psoriasis outcomes and comorbidities. JAMA Dermatology, 156(2), 183-191.

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